Adolescent mental health declined in many European countries between 2014 and 2018, a new report has found.
The authors of the study, published by the European office of the World Health Organisation (WHO), said that how authorities responded to the growing problem would define the mental health of today's young people for years to come.
They warned that the issues were likely to be compounded by the COVID-19 'lockdown' which has seen schools shut and many children isolated.
The conclusions were based on more than 227,000 young people aged 11, 13, and 15 from 45 countries who took part in the international Health Behaviour in School-aged Children (HBSC) study.
It found that 1 in 4 adolescents reported feeling nervous, irritable, or having difficulties getting to sleep at least once each week.
It should be "a concern for us all", said Dr Hans Henri Kluge, WHO regional director for Europe.
"How we respond to this growing problem will echo for generations," he warned.
Medscape News UK spoke to Dr Jo Inchley, from the Institute of Health and Wellbeing at the University of Glasgow, who is the HBSC International Coordinator. We asked her first of all about adolescent mental health in the last few years and the implications that the pandemic might have for the future.
It is timely in that respect, giving us a baseline against which we can assess some of the longer-term impacts of COVID-19.
We're seeing some concerning trends around mental health of young people.
We've seen some of those trends for the last few years, particularly in the UK and other Western European countries. And there's evidence that those are continuing to decline.
So, I guess the current COVID-19 situation has the potential to exacerbate some of those issues for young people.
We see quite high levels of feeling low, for example. And I guess the current situation is likely to be increasing young people's feeling of loneliness, social isolation, or anxiety about family, friends, and about the future.
It's putting mental health in the spotlight, and in a sense that's a good thing because we really need to be investing and supporting young people when they are feeling particularly vulnerable and unsure about what's going on now, and unsure how that's going to impact on their future.
What do you think were the main triggers for poor and declining mental health during the period that you measured in European countries?
Obviously, mental health is a really complex area, and there's many, many different factors which will affect that. Everyone's experiences are different.
We're not just talking about mental illness, we're talking about 'feeling low'. Some of these subclinical issues that affect young people on a day-to-day basis seem to be getting worse, and schools are having to address them.
That's why it's really important that we shine a light on some of these issues so that we can support young people in an appropriate way.
I think there is a cluster of findings which seem to be connected to this.
We don't look at the connections in the report specifically but what we are seeing are things like increases in sleeping difficulty – they’ve increased in around half of countries across all ages in the last 4 years, so I think that's quite a significant trend.
Obviously, young people's use of digital technology and social media is increasing. And we looked at problematic social media use for the first time.
Around 1 in 10 young people in the UK are reporting problematic social media use, when it begins to interfere with daily life, other activities, and relationships with your family, for example.
And I think the other area which is notable is around life at school. Many countries are also reporting increases in school work pressure. So, the number of young people who feel under a lot of pressure from school work is going up.
Alongside that, we're also seeing a decrease in those who say they like school.
So, there's something around the school experience, something around sleep, something around social media use, and something around mental health. It's very likely that some of those are connected.
Did the report highlight specific mental health issues for young people in the UK?
If I tell you some good news first.
We are very low on bullying other people. Many schools have implemented anti-bullying policies in recent years, so it's good to see that we're relatively low in terms of bullying perpetration.
But we're also quite high in terms of bullying victimisation, so there's two sides of that coin.
In recent years we've seen really marked declines in substance abuse, alcohol use, cigarette smoking. There's some indication that that's continuing but it's definitely slowing down, and in some cases we're seeing small increases: for example, Wales is showing some small increases in alcohol use again.
The risk of poor mental health seems to increase as adolescents get older. Also, girls were more likely than boys to be at risk. Why do you think that is?
It's a really strong trend that we're seeing.
Particularly, our 15-year-old girls are reporting very poor mental health.
Again, many issues may play into that but one of the issues, perhaps, is that girls do tend to internalise issues more. They may be absorbing more stress on a day-to-day basis; they may be more concerned about academic pressure, which might be adding to anxieties that they're feeling; they may be more vulnerable to, for example, some of the negative influences through social media.
So, we have to be careful about not over-generalising with these differences, and we're seeing, increasingly, boys reporting poor mental wellbeing as well, so we do need to pay attention to the boys as well as the girls.
But at the moment, girls are particularly at risk. And girls, in the UK, are reporting particularly high levels of pressure from schoolwork, so I think something around academic expectations or academic pressure [is something] that we need to look at.
What do you think countries in general, and the UK in particular, could do better? We hear a lot about the difficulties for young people in accessing mental health services, for example.
We hear a lot about mental health services being at breaking point, with high demand and not enough resources to meet the needs at the moment.
We definitely need more investment in that area.
But it's not just about young people who actually need health services or specialist support – a lot of these issues affect all young people in schools, and their families, and it's having an impact on relationships with friends and other aspects of life.
I guess we're looking at how families and schools can really support young people better. We know that the UK is not doing so well for things like family meals, family support, and support from friends and classmates.
I think we need to think about how we can provide better social support for young people as they grow through adolescence.
Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada: Report